Post Traumatic Stress Disorder (PTSD)

Background

Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. People with PTSD also experience emotional numbness and sleep disturbances, depression, anxiety, and irritability or outbursts of anger. Feelings of intense guilt are also common. Physical symptoms such as headaches, gastrointestinal distress, immune system problems, dizziness, chest pain, or discomfort in other parts of the body are common in people with PTSD.

The Veterans Administration (VA) and the Department of Defense (DoD) have developed a clinical practice guideline designed to assist primary care providers in an ambulatory care setting evaluate and manage patients with PTSD -  VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress Disorders, Jan 04. The PTSD CPG is one of the supporting guidelines for the DoD/VA Clinical Practice Guideline for Post-Deployment Health Evaluation and Management (PDH-CPG), Dec 01, which was developed to assist primary care providers in evaluating and providing care for individuals with potentially deployment-related health concerns and conditions.

The DoD Deployment Health Clinical Center has developed an intensive, three-week, multi-disciplinary treatment program, The Specialized Care Program (SCP) Track II, for service members experiencing PTSD or difficulties re-adjusting to life upon redeployment after service in OEF/OIF. The SCP is for patients who have had other treatments for PTSD (or perhaps depression) but continue to experience symptoms that interfere with functioning. It is also for patients who have no other treatment available to them.

Table of Contents

• Clinical Guidance
• Implementation Guidelines
• Tools
  • VA/DoD PTSD CPG Tools
  • PDH-CPG Desk Reference Toolbox
  • PTSD Assessment Tools
  • Brochures and Fact Sheets
• Other Related Information
• Education and Training
• Research
• Related Links

Clinical Guidance

• VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress Disorders, Jan 04
  • Complete Guideline
• DoD/VA Clinical Practice Guideline for Post-Deployment Health Evaluation and Management, Dec 01
• VA National Center for PTSD (NCPTSD)
• NCPTSD and WRAMC, The Iraq War Clinician Guide 2nd Edition, Jun 04
• Screening for PTSD in a Primary Care Setting Fact Sheet
• FAQs About PTSD Assessment: For Professionals
• A Clinician's Guide to Medications for PTSD
• Institute of Medicine (IOM) of the National Academies
• Treatment of Posttraumatic Stress Disorder An Assessment of the Evidence, 2007
• Posttraumatic Stress Disorder: Diagnosis and Assessment, 16 Jun 06
• Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), PTSD Treatment Options
• DHCC Specialized Care Program (SCP)
• UK National Collaborating Center for Mental Health, Post-Traumatic Stress Disorder. The management of PTSD in adults and children in primary and secondary care. 2005
• American Psychiatric Association, Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder, Nov 04
• Psychiatryonline Web Page with APA ASD and PTSD Practice Guideline, clinical tools and related links
• American Psychological Association Practice Update, Clinical Conversation on Treating Post-Traumatic Stress Disorder (PTSD) Related to Military Combat, 14 Feb 08
• International Society for Traumatic Stress Studies, Effective Treatments for PTSD, Second Edition, 2009
• Center for the Study of Traumatic Stress Fact Sheet, Evidence-Based Management of Posttraumatic Stress Disorder (PTSD)
• Posttraumatic Stress Disorder, Acute and Long-Term Responses to Trauma and Disaster, American Psychiatric Press Inc., 1997

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Implementation Guidelines

• VA/DoD Manual for Facility Clinical Practice Guideline Champions, Oct 2007
• Rand Manual, Putting Practice Guidelines to Work in the Department of Defense Medical System, 2001

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Implementation Tools

• VA/DoD PTSD CPG Tools
  • Core Module Summary, Dec 03 including:
    • Post-Trauma Acute Stress Reaction (ASR) Civilian Population – Module A1 Summary
    • Management of Stress Reactions Combat and Operational Stress Reaction (COSR) During Ongoing Military Operations - Module A2 Summary
    • D and PTSD in Primary Care – Module B Summary
    • Mental Health Specialty – Module C Summary
    • Pharmacotherapy Interventions – Interventions Module Summary
  • Acute Stress Reaction (ASR) Module - Pocket Guide, Apr 05
  • ASD/PTSD in Primary Care – Pocket Card, Jan 04
  • Key Points Card, Dec 03
• PDH-CPG Desk Reference Toolbox
  • Post Traumatic Stress Disorder (PTSD) Provider Reference Pocket Card
• PTSD Assessment Tools
  • NCPTSD Assessment Tools
  • ISTSS Assessment and Treatment Resources
  • Clinician-Administered PTSD Scale (CAPS)
  • Standard Health Assessment Tools [including PTSD Checklist (PCL)]
• Brochures and Fact Sheets
  • National Institute of Mental Health (NIMH) Post-Traumatic Stress Disorder Booklet, 2008
  • NCPTSD Fact Sheet, FAQs About PTSD Assessment (For the Public)
  • NCPTSD Fact Sheet, What is Posttraumatic Stress Disorder (PTSD)?
  • NCPTSD For Veterans and the General Public (Contains in depth information on PTSD and traumatic stress for a general audience)
  • USACHPPM, A Soldier's Guide to Combat-Related Stress Problems, Jan 06
  • USUHS Fact Sheet, Evidence-Based Management of Posttraumatic Stress Disorder
  • Journal of the American Medical Association (JAMA) Patient Page on Posttraumatic Stress Disorder
• Coding Guidelines
  • Air Force Medical Service Mental Health Coding Handbook, Apr 08

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Other Related Information

• Naval Center for Combat and Operational Stress, Article entitled Can a Veteran Go into Law Enforcement After a PTSD Diagnosis? Law Enforcement's View of Hiring Veterans with PTSD, 2008



• TRICARE Behavioral Health Care Services Chart from TriWest
  
  
• RAND Report: Invisible Wounds of War, Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, 2008



• Emotional Aftermath of the Persian Gulf War - Veterans, Families, Communities, and Nations, American Psychiatric Press Inc., 1996

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Education and Training

• Healthcare Provider
• RESPECT-Mil  (RESPECT-Mil, which stands for Re-Engineering Systems of Primary Care Treatment in the Military, is a system of primary care designed to enhance the recognition and high-quality management of Post-Traumatic Stress Disorder (PTSD) and depression. The US Army Medical Command has directed wide implementation of RESPECT-Mil in Army primary care facilities. Tri-service implementation is in the planning stages. Web-based training for the program is available at this Web site.)

• National Center for PTSD

• NCPTSD Training and Educational Materials for Health Care Providers Web Page
• NCPSTD Video, The New Warrior: Combat Stress and Wellness – Provider Perspectives, 2005 (73 minutes)

• TRICARE Pilot Education Program for Civilian Providers on PTSD and TBI (Offers 17 Continuing Education Units.  Direct care providers can take advantage of this CME educational opportunity through their existing MHS Learn accounts.)

• Military Health System Clinical Quality Management (MHS-CQM) (formerly NQMP)

• National Quality Management Program (NQMP) Special Study, Post-Deployment Post-Traumatic Stress Disorder (PTSD) Screening Fact Sheet, Jan 06
• National Quality Management Program (NQMP) On-Line Education (CEU Presentation) Post-Deployment Post-Traumatic Stress Disorder (PTSD) Screening, Sep 06 (Review of the findings of the NQMP 2005 Special Study on Post-Deployment Post-Traumatic Stress Disorder (PTSD) Screen. Includes suggestions to help primary care providers identify patients as soon as possible who may need further evaluation or treatment and provides resource web links.)

• VA, Veterans Health Initiative, Independent Study Course, PTSD: Implications for Primary Care
• MedlinePlus:Post Traumatic Stress Disorder Page
• Center for Deployment Psychology  (The CDRP located at the Uniformed Services University of the Health Sciences was developed to promote the education of psychologists and other behavioral health specialists about issues pertaining to the deployment of military personnel.)

• Servicemember/Family

• The Wounds Within (Department of Defense web broadcast on post traumatic stress disorder, Jan 07)

• Army PTSD/mTBI Chain Teaching Program

• Mild Traumatic Brain and Post Traumatic Stress Disorder Facilitator's Guide, 2007

• Healthy Roads Media Video, Post-Traumatic Stress Disorder (PTSD) (6 min 35 sec) (in Spanish)
• National Center For PTSD Video: The New Warrior: Combat Stress and Wellness – Perspectives for Veterans and Their Families, 2005 (47 minutes)  

Research

• Department of Veterans Affairs Health Services Research and Development Service, The Assessment and Treatment of Individuals with History of Traumatic Brain Injury and Post-Traumatic Stress Disorder: A Systematic Review of the Evidence, Aug 09
• Advancing Research Standards for PTSD Interventions: Suggested Approaches for Designing and Evaluating Clinical Trials, Jan 08 (Summary of a meeting convened by VA in collaboration with NIMH and DoD)
• Mental Health Advisory Team (MHAT) Reports I,II,III,IV,V, and VI
• Institute of Medicine Report, Treatment of PTSD: An Assessment of The Evidence, Released 17 Oct 07
• GAO Report 06-397, Post-Traumatic Stress Disorder - DoD Needs to Identify the Factors Its Providers Use to Make Mental Health Evaluation Referrals for Servicemembers, May 2006
• National Quality Management Program (NQMP), Post-Deployment Post-Traumatic Stress Disorder (PTSD) Special Study Fact Sheet, 2006
• USUHS Center for the Study of Traumatic Stress
• The International Society for Traumatic Stress Studies
• European Society for Traumatic Stress Studies (ESTSS)

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Related Links

• Federal
• VA, National Center for PTSD
• DHCC Combat/Operational Stress Page
• afterdeployment (The Military Health System's mental wellness resource Web portal for service members, veterans, and military families suffering post-deployment mental health problems.)
• Army Behavioral Health Web Site
• Defense Centers of Excellence For Psychological Health & Traumatic Brain Injury Web Page
• DCoE Outreach Center
• DoD Mental Health Self-Assessment Program
• National Institute of Mental Health Post-Traumatic Stress Disorder (PTSD) Page
• U.S. Army MEDCOM Quality Management Office
• VA War Related Illness and Injury Study Centers (WRIISC)
• TriWest Behavioral Health Portal
• America's Heroes at Work (Department of Labor project that focuses on the employment challenges of returning service members living with Traumatic Brain Injury (TBI) and/or Post-Traumatic Stress Disorder (PTSD)).


• Other
• American Psychological Association Posttraumatic Stress Disorder Page
• National Mental Health Association
• National Alliance on Mental Illness Post-Traumatic Stress Disorder Page
• Association for Behavioral and Cognitive Therapies (ABCT)
• Anxiety Disorder Association of America Posttraumatic Stress Disorder (PTSD) Page
• David Baldwin's Trauma Information Pages (Emotional trauma and traumatic stress, including PTSD and dissociation)
• Gateway to Post Traumatic Stress Information
• American Academy of Experts in Traumatic Stress
• Gift From Within (An International Nonprofit Organization for Survivors of Trauma and Victimization)
• National Child Traumatic Stress Network (NCTSN) (Collaboration of academic and community-based service centers funded by the Substance Abuse and Mental Health Services Administration)

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